Treating addiction and pain
Ann Arborite Herbert Malinoff
Pain. A typical dictionary definition is "an unpleasant sensation." But "Samantha," who lived with chronic pain for eighteen years, has her own definition.
"It was like a sumo wrestler was sitting on my chest," says the forty-three-year-old Ann Arborite. "That's what it felt like to breathe. I could never get enough air, and every bone and muscle in my body ached." She saw an assortment of doctors, took seventy prescribed pills daily, and slept for twenty hours at a stretch.
Hopeless and suicidal, Samantha was beginning to think that all was lost.
Until she was sent to Dr. Herbert Malinoff.
Although not a psychiatrist, "he listened to me more than any psychiatrist ever had," she says. He learned about her traumatic childhood and made connections between her physical and emotional pain. Seeing Samantha weekly at first, he removed her from many medications and got her involved in a chronic pain relief program. Seven years later, Samantha is working on a master's degree and describes herself as "ninety-five percent recovered."
Trim, with salt-and-pepper hair and a white lab coat, Malinoff, fifty-seven, looks like a TV doc. A U-M undergrad and med school grad, Malinoff did fellowships in oncology and nuclear medicine but now specializes in chronic pain, addiction, and detoxification. He's a faculty member at the U-M's Back and Pain Clinic, an attending physician at St. Joe's, and has his own clinic, Pain Recovery Solutions, in Ypsilanti.
Malinoff says a third of his patients suffer various sorts of chronic pain, including fibromyalgia, pelvic pain, headaches, and irritable bowel. Another third have a chemical dependency to alcohol, nicotine, prescription medications, or street drugs. And the remaining third are battling both chronic pain and chemical dependency or addiction.
"The patients I take care of are the ones other doctors don't want to take care of," Malinoff says. "They drive other doctors crazy."
The key to his approach, Malinoff says, is identifying something called comorbidity: the presence of one or more disorders or diseases in addition to the
patient's primary complaint. Malinoff grabs a piece of paper, warns that he's a lousy artist, and draws four overlapping circles. He labels them chronic pain, psychiatric illness, medical illness, and addictive illness.
"I look at the four separate areas, synthesize what's going on in each one, and identify what's missing," he says.
Malinoff then tears off another blank page from the tablet, draws the same four overlapping circles, but labels them body, brain, emotional, and spiritual. These reflect different facets of treatment. For example, he says, many women with fibromyalgia also suffer from psychiatric distress or a sexual trauma. Taking even a "baby step" in one of these areas-which can be as simple as attending a worship service or doing volunteer work-can improve a patient's quality of life.
And for many patients, he prescribes buprenorphine. "It's the most important treatment to come along for both addiction and chronic pain in the past fifty years," Malinoff says of the drug, which has been around since the 1970s and is now sold under the brand names Suboxone and Subutex. Malinoff says he has seen hundreds of patients improve on the medication.
Jason Schwartz, Dawn Farm's clinical director, says "we are big fans of Suboxone for detox" and that the organization works with Malinoff and other doctors who prescribe it. Still, Schwartz adds that Dawn Farm is concerned that the drug is "being used more and more for maintenance." Dr. Mark Greenwald, a Wayne State professor who has studied buprenorphine, says the drug's usefulness as a painkiller is much less established than its effectiveness in helping wean addicts.
Pain Recovery Solutions' office is bathed in comforting earth tones and punctuated by splashes of color. Framed inspirational messages are everywhere. Malinoff reads one aloud: "The afternoon knows what the morning never suspected."
He ponders the Swedish proverb and offers an example: "Now I can look back twenty years later and say, 'Oh, yeah, that sure was the case,' but at the time I couldn't see a thing."
Malinoff isn't speaking as a doctor but as a recovering pain medication addict and alcoholic.
"I got help only because I was intervened upon," Malinoff admits. In 1990, the state medical board mandated that he get treatment for chemical dependency and lifted his medical license. He was unable to work as a physician for almost two years.
Malinoff has been involved in a recovery program ever since. Though he does not characterize himself as particularly religious, he does recognize a power greater than himself and says that he couldn't have turned things around without spirituality.
"There are things that have happened to me that could have never happened on my own strength," he says. "I never could have gotten sober on my own, and I never could have gotten my medical license back on my own."
While Malinoff doesn't advertise his personal experience, he has no qualms about discussing it with a patient when he feels it might help.
"The patients who come to me are so full of shame, guilt, and self-hatred that it helps to see someone who is a wearing a shirt, tie, and white coat who says 'This [the addiction] is an illness, just like diabetes is an illness, and there's no shame in having an illness - assuming you do the right thing and take care of it.'"
Malinoff is "brisk and won't be a bleeding heart guy," writes one patient on the website RateMyDoctor.com. "Part of what makes him a success is that he is a recovering addict himself. Nothing you can tell him he hasn't gone through himself."
Married for twenty years to his second wife, Lynn, Malinoff has two grown sons, Aaron, twenty-six, and Gabriel, thirty-one. He will tell you that he's "really-really-ready for grandkids."
Malinoff says he loves his job. "I get to see patients that are sad, sick, and sorry, and inside of a few weeks to months, I see a complete transformation in their attitude."
[Originally published in August, 2009.]